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The Integrated Memory Care Clinic is a patient-centered medical home led by advanced practice RNs (APRNs) who provide dementia care and primary care simultaneously and continuously. We explored the experiences of 12 informal caregivers of persons living with dementia during their first year at the Clinic. Data were analyzed via directed content analysis. Caregivers described the Clinic as “the only place you should go to for dementia [care].” Caregivers felt a sense of belonging to the Clinic, valued APRNs' competence and staff's dedication, and round-the-clock telephone access to APRNs. Caregivers also acknowledged that “we're all out here swimming on our own.” They expressed their sense of being overwhelmed and needing more services and medical and non-medical resources, and more prognostic information on dementia. Although the Clinic is beneficial for caregivers, caregiving demands exceed the supply of services and resources at the Clinic. [ Research in Gerontological Nursing, 14 (2), 69–78.]

The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC). IMCC advanced practice registered nurses provide dementia care and primary care simultaneously and continuously to PLWD until institutionalization. Changes were examined in caregivers' psychological well-being (perceived stress, depressive symptoms, caregiver burden, and anxiety) and health status and in PLWDs' quality of life and neuropsychiatric symptoms. Data were collected at baseline, then 3 and 6 months post-baseline. Forty-two caregivers completed all 3 assessments. Most variables remained unchanged. Statistically significant improvements in 5 sub-scales of the Neuropsychiatric Inventory were observed: caregivers' distress regarding their PLWDs' delusions and anxiety, and PLWDs' severity of delusions, depression, and total symptom severity. Further testing of the IMCC is required, including in quasi-experimental studies, to determine its efficacy.

In reports of randomized controlled trials, thorough description of the attention control condition has been recommended, yet is frequently lacking. The Tele-Savvy Caregiver program for informal caregivers of persons living with dementia was tested in a randomized controlled trial with an attention control condition. The purpose of this trial was to test Tele-Savvy’s efficacy in reducing the negative effects of caregiving on caregivers, promoting quality of life for persons living with dementia, and improving caregiver mastery. We describe the design and implementation of and examine the outcomes associated with the attention control condition. Caregivers were randomized to the immediate Tele-Savvy (active condition), Healthy Living (attention control), or waitlist. The attention control content was focused on healthy lifestyle and was not intended to affect the outcomes that Tele-Savvy targeted. The attention control group was similar to Tele-Savvy in the intervention structure and duration: it consisted of seven weekly group videoconferences and 36 video lessons. Data on outcomes of caregivers and persons living with dementia were collected at baseline and three and six months post-baseline. Multilevel mixed effects models were used to determine changes in the outcomes. One hundred and eleven caregivers were randomized to the attention control condition (attrition 21.6%). Eighteen formative assessment interviews focusing on caregivers’ experience in the attention control condition were conducted. The attention control condition completers had no statistically significant changes in the variables that Tele-Savvy targeted. These results may be used in the design and implementation of attention control conditions in behavioral intervention research.

The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal.To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49).Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics.Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life.Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being.Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.

Background and Objectives Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving. Research Design and Methods A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6–8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions. Results Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients’ behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found. Discussion and Implications Findings attest to program efficacy and the viability of employing distance means to improve family caregivers’ emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.

A telehealth program supports meaningful partnerships between urban geriatric specialists and rural health care providers to facilitate increased access to specialty care.

Introduction: This study examined the feasibility and efficacy of Tele-Savvy, an online version of the Savvy Caregiver Program, a psychoeducation program for caregivers caring for a person with dementia. Methods: A convenience sample of 22 caregivers from the Atlanta VA and 42 caregivers from 14 different states enrolled in Tele-Savvy. Pre- and post-program evaluations assessed caregiver burden, caregiver competency, and frequency of behavioral and psychological symptoms of dementia (BPSD). Results: Fifty-seven caregivers completed the 6-week Tele-Savvy program. Caregivers whose care recipients exhibited higher average BPSD frequency at baseline demonstrated significantly greater burden decreases post-program. Caregivers of care recipients in more advanced dementia stages demonstrated a significantly greater improvement in caregiver competence. Discussion: The results point to the feasibility of achieving significant results in caregivers’ well-being and care recipients’ BPSD with a fully online program. Tele-Savvy may be particularly efficacious for caregivers whose care recipients exhibit higher BPSD frequency and are in later dementia stages.

By 2050, almost 16 million Americans may live with dementia and will rely predominantly on informal caregivers for support. In providing this support, caregivers frequently suffer a wide range of adverse consequences. Although established psychoeducation programs benefit caregivers, attending in-person programs is challenging for caregivers who must find time, transportation, and substitute care, all of which come with expenses. To address this challenge, the Savvy Caregiver Program, an evidence-based psychoeducation program with demonstrated effectiveness for caregiving and disease-related outcomes, was transformed into an on-line program, Tele-Savvy. This article describes the rationale for and design of a prospective longitudinal randomized controlled trial (n=270), currently underway. The trial aims to establish Tele-Savvy’s efficacy in (i) reducing the negative effects of caregiving on caregivers; (ii) promoting care recipients’ quality of life; (iii) improving caregiver mastery; and (iv) to explore Tele-Savvy’s efficacy among caregivers of different races/ethnicities. The mediating role of mastery on Aims 1 & 2 outcomes will be assessed. Participants are randomized to the active condition (immediate Tele-Savvy participation), attention control, or usual care. Participants in the two latter conditions complete Tele-Savvy six months post-baseline. Multilevel mixed effects models will be used to examine changes in outcomes and model group by time interactions (months since baseline). The exploratory aim will be addressed using analysis of covariance and qualitatively. This trial’s results may be used by healthcare and community organizations to implement Tele-Savvy into dementia care, increasing caregivers’ access to this evidence-based intervention.

The population of individuals living with dementia and their caregivers and the need to provide caregiver training will increase in the next several decades. In-person caregiver educational programs are delimited by logistical and resource boundaries that could be overcome with online programs. The purpose of this qualitative descriptive study was to explore the acceptability and ways to improve the content and delivery of an online 7-week psychoeducational pilot program—Tele-Savvy. Thirty-six caregivers who completed the pilot were interviewed about their experience with Tele-Savvy and their suggestions for its improvement. Conventional content analysis allowed for the identification of three themes: barriers and facilitators to establishing rapport with participants and instructors, content enrichment and diversification, and structural refinement. These lessons learned directly from the caregivers provide evidence to guide the refinement of analogous online interventions and highlight the need for their wider availability.

Frailty, a reduction in reserve capacity in people who are otherwise considered healthy, affects between 9 and 13% of adults who are older. Frailty is a poorly understood syndrome; however, frailty is correlated with negative CV procedure outcomes, falls and institutionalization. Little is known about frailty in caregivers. A secondary data analysis was conducted using the REACH II publicly available dataset and the Groningen Frailty Index (GFI). At consent two percent of REACH II caregivers had difficulty going to the toilet while 11% had difficulty walking outdoors. More than 1/3 had hearing and vision losses. 75% felt sad or dejected. 82% were taking more than 4 medications. Based on their calculated GFI, between 61% and 64% of the REACH II caregivers were frail. Frail caregivers and their care recipient were less likely to go to the emergency department (-0.110 coefficient; p = 0.004 95% CI -0.184 -0.035) and were less likely to be hospitalized overnight during the past 6 months (-0.121 coefficient; p=0.004; 95% CI -0.203 -0.040). Frailty is an under-recognized syndrome in caregivers. Little is known about the impact of frailty on the caregiving dyad; however, ED utilization and hospitalization was decreased in these caregivers and their care recipients. This decrease may imply a delay in seeking care; and, in fact, lead to worse health outcomes for the dyad. With the aging of Baby Boomers and the continued dependence for long term care delivered by unpaid caregivers, implementation of programs to prevent and treat frailty in caregivers is essential.

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide both dementia care and primary care. We explored the experiences of informal caregivers of persons living with dementia at the IMCC during their first year post-enrollment. Twelve caregivers completed semi-structured telephone interviews that lasted 29 minutes on average. The data were analyzed via directed content analysis guided by attention only to caregivers’ accounts of their experience at the IMCC. Caregivers’ experiences clustered around two major considerations: the strengths of the IMCC, and ways to enhance the IMCC. Overall, caregivers’ viewed the IMCC as their wished-for care model. Caregivers felt a sense of belonging to the IMCC team, as they understood that the IMCC personnel incorporate caregivers’ input to deliver care. Participants valued APRNs’ competence in dementia care and having direct telephone access to an on-duty APRN around the clock. Caregivers appreciated the care organization at the IMCC with adequate time dedicated for in-person visits. Areas for the IMCC improvement included clarifying the IMCC scope of practice, explaining dementia progression, involving physicians, and providing more medical and non-medical resources at the IMCC. Caregivers’ willingness to have more resources provided by the IMCC emphasizes how many unmet needs caregivers and their persons have. Clarification of the clinics’ scope of practice – what can be done to manage dementia, its symptoms, and comorbidities – highlighted the need to educate caregivers about ways in which dementia, albeit incurable, can be managed.

The physical environment is fraught with potential dangers that can jeopardize the safety of a person living with dementia and his or her family carepartner. For rural Veterans, one common source of danger is the presence of firearms in the home environment. A loaded gun in the house becomes particularly problematic as dementia progresses and cognition and capacity become compromised. However, the second amendment guarantees United States Citizens the right to keep and bear arms. In this paper we present preliminary data on a sample of 18 rural Veterans and their carepartners who participated in a tele-dementia assessment as part of the national GRECC Connect program. All but one Veteran (94%) had a diagnosis of dementia and was accompanied by a family caregiver (89% spouses). The dyads underwent an in-person psychosocial interview battery administered by the team research psychologist followed by a comprehensive clinical assessment conducted with the clinic geriatrician via tele-video-conferencing. Fifty-three percent of the Veterans seen were over 80 years of age. Sixty-seven percent scored 10 or below on the St Louis University Mental Status (SLUMS) examination indicating impaired cognition and suggestive of reduced capacity. Seventy-eight percent of the sample carry a loaded gun and 83% keep one in the home and/or vehicle. Qualitative comments from the caregivers include fear and discomfort with the firearms in the home. A case study is presented to illustrate the challenges encountered with providers, family members and law enforcement. Results are discussed in terms of clinical, practical and policy implications.

A control group is an essential element in the design and conduct of a randomized controlled trial, yet few participants wish to subject themselves to a sham treatment or placebo condition. The Tele-Savvy Healthy Living Attention Control Group was created with this in mind and with respect for and acknowledgment of the busy day to day lives lead by caregivers who are providing care to a person with dementia. We conducted qualitative interviews with a sample of caregivers following their participation in the seven-week control condition to elicit their perceptions regarding the utility of the program and experience in the group. Specific questions referred to the program’s influence on their self-care behaviors and caregiving experiences. Emergent themes included: (a) good nudge, (b) minimal change in lifestyle, and (c) no time for healthy living. These findings provide behavioral researchers with options to consider when designing control groups within randomized controlled trials.

This symposium reflects the theme of the conference “The Purposes of Longer Lives” by describing the challenges encountered by behavioral researchers faced with the formidable task of identifying a valid, scientifically sound control group for a randomized controlled trial (RCT) that simultaneously holds some sense of meaning and purpose for the older adults enrolled in the trial. In this symposium an ongoing NIH sponsored RCT for caregivers caring for persons living with dementia serves as an exemplar and template to illustrate key issues in the design, development, and implementation of valid and ethical control groups. The first paper delineates the rationale for an attention control group and explicates the methodological, ethical and logistical issues that were systematically addressed and overcome. The second paper details the key elements and outlines the weekly content comprising the “Tele-Savvy Healthy Living Attention Control Group” curriculum. The third paper discusses themes and main points extracted from qualitative interviews conducted with a sub-sample of Caregivers following participation in the control condition. In the fourth and final paper we address the critical question: “If we build it will they come?” by reporting a comparison of participation and attrition rates for the control and active conditions and presenting a brief analysis of field notes collected from several cohorts during the weekly group conferences. The Healthy Living Attention Control Group is offered and intended for use as a resource for behavioral researchers who are designing or currently engaged in randomized controlled trials.

This discussion will briefly outline the mechanical and pragmatic elements that factored into the control group selection and design of an attention control group for a caregiving program delivered via technology. There will also be a discussion of the substantial challenges encountered and overcome in the process of constructing a meaningful and beneficial program distinct from the active Tele-Savvy content. The resulting program consists of seven weeks of video modules and corresponding workbooks and materials. The Healthy Living Attention Control Group program incorporates evidence-based, vetted information (e.g., NIA Go4Life; USDA ChooseMyPlate and CDC) on healthy lifestyle behaviors (e.g., diet, exercise) with additional content developed specifically for the program by content matter experts. The 50+ video modules can be modified and adapted to correspond to a variety of technology enabled, Tele-delivered interventions and will be highlighted in this outline with additional focus on retention of the control group.

Telehealth is becoming more prevalent in geriatrics. In the multisite randomized controlled trial of Testing Tele-Savvy, we aimed to investigate what makes telehealth effective. In this sub-study, we explored how group facilitators contributed to study success. Technical navigators observed facilitators in 42 Tele-Savvy (interventional) and 42 Healthy Living (control) sessions since the study’s beginning in August 2017. Navigators observed how facilitators interacted with participants, engaged them, and managed difficulties with videoconference participation. They interviewed facilitators about their experience running videoconferences. Facilitators were instrumental in achieving high level of participant engagement by creating an interactive and supportive environment. They encouraged caregivers to share their experiences and opinions. These exchanges strengthened connections between participants, resulting in high levels of task completion. Facilitators are central to the success of Tele-Savvy. We recommend facilitators be trained to manage videoconference-based programs to reach caregivers with limited access to support.

While the VA has a plethora of evidence-based caregiving support programs, many with tele-health components, these programs remain “siloed”- available only to caregivers who live where the program is offered. To help increase access to services, this quality improvement project, DELIVER Caregiving funded by the VA’s Office of Rural Health developed an innovative infrastructure to: a) assess the needs of rural Veterans living with dementia and their caregivers and b) facilitate access to existing resources and tele-health programs that are personalized, proactive, Veteran-centric, accessible from home and, aligned with individualized needs and preferences. First, we are testing the viability of conducting a comprehensive telephone-based needs assessment using the Benjamin Rose Institute Care Consultation (BRI-C) Platform, to triage Veteran/caregiver dyads to programs that best meet their needs. DELIVER care consultants will guide caregivers in identifying issues they would like to address, help the develop a step-by-step action plan to address their needs, and build ongoing relationship focused on prevention and monitoring caregivers to support them as they work toward their goals. If the BRI-C is found to be viable, we will validate the platform’s ability to target and match Veterans and caregivers’ needs and preferences via a comprehensive needs assessment and referral infrastructure. We hypothesis that the DELIVER program will have an impact on caregivers’ burden, depression, self-efficacy and Veterans’ healthcare utilization and quality of life.

The focus of the “Healthy Living Control Group” is on wellness in an effort to provide meaningful and potentially beneficial activities for wait-list control caregivers whose active condition counterparts are receiving the Tele-Savvy Psychoeducation program. We developed as ethical, feasible and attractive a control group as possible while limiting exposure to programmatic elements theorized to influence our outcomes. This resulted in an evidence-based seven-week asynchronous video program with weekly synchronous facilitator lead caregiver groups—a condition comparable to the active Tele-Savvy arm in terms of social support, group effect, media exposure and the therapeutic relationship. This symposium is designed to stimulate conversation around the many factors in the design of control groups including: minimizing bias, and paralleling intensity, duration, frequency and equivalency of exposure to a therapeutic agent while balancing and respecting participant burden and time, adhering to methodological rigor, protecting against cross-contamination and compromised outcomes and minimizing spurious conclusions

In designing technologies and environments to support people aging with disability, it is critical to consider the characteristics of the individual. There are a number of personal factors that can impact one’s ability to maintain daily living activities, independence, and quality of life. Developed by TechSAge investigators, the Minimum Battery is a core set of background measures designed to capture relevant descriptive information about participants with long-term impairments (e.g., demographics, health, functional capabilities and limitations, technology use). The Minimum Battery is a self-report, multi-dimensional questionnaire developed with flexible administration options to facilitate data collection across studies and a repository database to enable large-scale archival analyses. This presentation will provide an overview of the Minimum Battery, highlighting preliminary insights on the sample to date (n = 173). Data snapshots demonstrate the potential value of the Minimum Battery as a holistic assessment of characteristics and support needs for this understudied population.

Individuals with Mild Cognitive Impairment (MCI) may have limited access to intervention programs that support their mental and physical health. The COVID-19 pandemic has put them at an even greater risk of not having access to such programs. While there is currently no cure, there is growing evidence that intervention programs may attenuate the progression from MCI to dementia, particularly those which 1) have potential to reduce the level of cardiovascular risk factors, 2) employ cognitively stimulating activities, and 3) create opportunities for social interaction (Petersen, Lopez, Armstrong et al., 2018; Wayne, Yeh, & Mehta, 2018; Mortimer, Ding, Borenstein et al., 2012). Many mind-body interventions, such as tai chi, yoga, and mindfulness classes, contain these three elements and have been shown to benefit individuals diagnosed with MCI, including improving cognition (e.g., Wells, Kerr, Wolkin, et al. 2013; Yang, 2016). Tele-technology (i.e., technology that supports communication between people who are not co-located) can aid in overcoming the logistical barriers by bringing instructors and interventions to these individuals to help them stay engaged and attend activities more frequently from the comfort and convenience of their home. We will present recent findings from a user study with 8 stakeholders (4 subject matter experts, 2 individuals with MCI, 2 care partners) to assess barriers and facilitators to using tele-technology to bring instruction of mind-body interventions to individuals diagnosed with MCI. This poster will present guidelines for delivering such interventions based on our findings from the user study, including safety and training protocols.

People with disabilities acquired in early to mid-life are living longer, contributing to growing numbers of older adults who are aging with disability, an understudied population likely to be underserved.This paper demonstrates the usefulness of the TechSAge Minimum Battery as a holistic assessment of health for people aging with disabilities.Survey data of socio-demographic and health characteristics were collected from 176 older adults with long-term vision, hearing, and/or mobility disabilities. A series of descriptive and bivariate analyses were conducted to illustrate the heterogeneity of the sample. An in-depth analysis of the subsample with vision difficulty was conducted to highlight the tool's value in assessing detailed contextual information for a specific disability.Prevalence of health conditions (M = 4.1; SD = 2.5), prescription medications (M = 4.1; SD = 3.9), and serious functional difficulties (M = 1.6; SD = 0.85) indicated a fair degree of comorbidity, but with considerable variation in number and type among individuals. Subjective health ratings were high overall, but lower scores were correlated with additional comorbidities (r = -0.31-0.40, p =.001). Analyses of the subsample with vision difficulty demonstrated heterogeneity in functional capacity, degree of impairment, duration, and use of supportive aids.Findings highlighted the heterogeneity among people aging with disability and demonstrated the importance of capturing multi-dimensional factors inclusive of an individual's capacity, context, and personal factors, which the Minimum Battery provides in an integrated assessment. Potential healthcare applications of the tool are discussed with implications for bridging aging and disability services.

Tele-Savvy is a 3-arm randomized controlled trial (RCT) of a psychoeducation intervention that equips dementia family caregivers with the knowledge and skills they need to provide care to their person, while also caring for themselves. This RCT is currently underway, with cohorts rotating through over a period of 12 months. The purpose of this presentation is to explore the effectiveness of Tele-Savvy (active) versus Healthy Living Intervention (attention control) or usual care (waitlist) on self-care behaviors among dementia family caregivers. We conducted semi-structured interviews with 16 caregivers after their initial participation in either the active, attention control, or usual care groups. Interviews elicited caregivers’ perceptions regarding the program’s influence on their self-care behaviors and engagement in self-care activities. The overall emerging theme for the family caregivers who participated in the Tele-Savvy and Healthy Living programs was “increased awareness of self-care activities”. Family caregivers in the Healthy Living program spoke mainly about engaging more in physical activities and improving their nutrition by eating healthier and keeping track of foods. Across all study groups, social engagement and having a support system were common self-care activities. Various limitations to engaging in self-care activities while in enrolled in the study included time and caregiving responsibilities. Suggestions were made for more respite services to become available to allow for family caregivers to engage in self-care activities. These findings provide researchers and practitioners with pertinent information to develop and refine programs for family caregivers to improve their self-care practices.

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses who seamlessly provide dementia care and primary care. This analysis explored predictors of significant changes in clients’ well-being and symptoms in clients’ first-year experience at the IMCC (N=42 caregivers, three assessments over nine months). The significant changes were decreases in caregivers’ distress regarding PLWDs’ delusions (Delusions-Distress) and PLWDs’ anxiety (Anxiety-Distress), and in PLWDs’ severity of delusions, depression, and total symptom severity. Mixed linear models were used to determine significant predictors among baseline sociodemographic characteristics that correlated significantly with outcomes that changed significantly over time. Caregivers not employed outside home had lower baseline Delusions-Distress (p=0.006) and slower decline in Delusions-Distress (p=0.015). The longer PLWD needed care, the lower baseline Delusions-Distress caregivers reported (p=0.023). Caregivers not living with their PLWD reported higher baseline Anxiety-Distress (p=0.016). Caregivers not employed outside home reported lower baseline Delusions-Severity for their PLWD (p=0.006). Caregivers not employed outside home reported PLWDs’ lower baseline depression severity (p=0.026). Older caregivers reported PLWDs’ lower baseline total symptom severity (p=0.002). Increase in caregiver’s age was associated with PLWDs’ higher total symptom severity (p=0.049). For PLWD with male caregivers, total baseline symptom severity was lower compared to PLWD with female caregivers (p=0.01). These findings highlight that PLWDs’ illness duration and caregivers’ employment status, living arrangement, age, and gender may determine their perception of their PLWDs’ symptoms. Clinicians may individualize caregiver education with the knowledge of such predictors.

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide both dementia care and primary care. In this prospective longitudinal cohort study we aimed to evaluate caregivers’ and their persons’ living with dementia (PLWD) (reported by caregivers) experiences at the IMCC. Changes in caregivers’ psychological well-being and health status and in PLWDs’ quality of life and neuropsychiatric symptoms were explored via three assessments during the clients’ first year at the IMCC. Forty-nine caregivers completed baseline assessments, including a sociodemographic questionnaire and established instruments. Mixed linear models were used to examine changes in caregiver- and PLWD-centered variables. With time as the only predictor and with full baseline sample included, significant changes were observed in caregivers’ distress regarding their PLWDs’ delusions (p=0.048) and in caregivers’ distress regarding their PLWDs’ anxiety (p=0.018). Additionally, significant changes were observed in PLWDs’ severity of delusions (p=0.032), depression (p

Responsibilities of caregiving for persons living with dementia make it challenging to participate in in-person research studies. Caregivers may be more willing to participate in studies that are online. This presentation will highlight recruitment strategies of a 4-site telehealth caregiver intervention for caregivers of persons living with dementia. Thus far, we have recruited 596 participants over the period of 2 years: 76, 189, 164 and 167 from each of the sites, respectively. Community partnership strategies such as presentations at churches and events organized by the Alzheimer’s Association, and the Alzheimer’s Disease Research centers, using a handshake protocol, and using social media sites such as Facebook and Twitter have all been effective at recruiting participants. Ongoing communication among the staff at different sites is also an important aspect of successful recruitment. These strategies have enabled recruitment to continue at a consistent rate and enabled the maintenance of relationships within the community.

Tele-Savvy is a 3-arm randomized controlled trial (RCT) of a psychoeducation intervention that equips family caregivers of people living with dementia with the knowledge and skills they need to provide care to their person, while also caring for themselves. This RCT is currently underway, with cohorts rotating through over a period of 12 months. The purpose of this presentation is to describe the effectiveness of Tele-Savvy (active) versus Healthy Living Intervention (attention control) or usual care (wait-list) on the caregiving experience among dementia family caregivers. We conducted semi-structured interviews with 16 caregivers at the 6 month time point and after their initial participation in either the active, attention control, or usual care groups. Interviews elicited caregivers’ perceptions regarding the program’s influence on their caregiving experience. Caregivers who participated in Tele-Savvy reported positive experiences such as recognizing that their experience has become more pleasurable and happier. They also shared that the program expanded their knowledge and allowed them to become patient while implementing caregiving strategies learned. Majority of caregivers who participated in the Healthy Living program indicated that nothing changed related to their caregiving experience. Half of the caregivers in the usual care group, expressed frustration and unhappiness, while the others expressed no change in their caregiving experience. Results suggest that psychoeducation caregiver interventions are meaningful and can enact positive changes in their outlook on caregiving. Thus, results of this study may guide future policies and further development of caregiver programs and interventions.

The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.

Introduction/Background Persistent sleep disturbance is one of the most highly prevalent symptoms after mild traumatic brain injury (mTBI) and is often refractory to conventional therapies. In the presence of co-existing post-traumatic stress disorder (PTSD), it is especially hard to treat. This randomized clinical trial (RCT) is to evaluate real acupuncture, as compared to sham, in improving persistent sleep disturbance in veterans with mTBI and PTSD. Material and method This RCT was conducted at a US Department of Veterans Affairs Medical Center and included sixty veterans aged 24–55 (mean 40) with history of mTBI of at least 3-months and refractory sleep disturbance. They were randomized into 2 groups and stratified by PTSD status. Each received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate. Results Mean [SD] pre-intervention global PSQI score was 14.3 [3.2]. Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, P = 0.04), and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, P = 0.0016). Effective blinding for active treatment was maintained throughout the study. PTSD participants presented with more significant sleep difficulties at baseline; acupuncture was effective for those both with and without PTSD. Conclusion Real acupuncture, compared to a sham needling procedure, resulted in a significant improvement in subjective and objective sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative medicine treatment modality like acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.

Summary We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans from three Veterans Affairs Medical Centers. Participants who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. Participants in the intervention arm were administered an exit interview to gather specific patient satisfaction data three months after their final outcome measure. The STeleR intervention consisted of three home visits, five telephone calls, and an in-home messaging device provided over three months to instruct patients in functionally based exercises and adaptive strategies. The outcome measures included Falls Efficacy Scale to measure fall-related self-efficacy and a Stroke-Specific Patient Satisfaction with Care (SSPSC) scale, a measure separated into two subscales (satisfaction with home care and satisfaction with hospital care) was employed to measure the participants’ satisfaction. At six months, compared with the usual care group, the STeleR group showed statistically significant improvements in one of the two SSPSC scales (satisfaction with hospital care, p = .029) and approached significance in the second SSPSC scale (satisfaction with home care, p = .077). There were no improvements in fall-related self-efficacy. Core concepts identified were: (a) beneficial impact of the trained assistant; (b) exercises helpful; (c) home use of technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional post-stroke rehabilitation.

This project was funded by the Department of Veterans Affairs (VA) as a part of a national pilot program to design interventions that would support caregivers of older veterans. The specific project described here employed in-home messaging units, which are already widely used by the VA in disease-management programs, as a device to educate and support family caregivers (CGs) of older, functionally impaired veterans. The primary goal of the pilot program was to improve the well-being of both family CGs and their veteran care recipients (CRs) by (a) engaging CGs more actively and effectively in their veterans’ care, and (b) directly addressing the emotional needs of caregivers themselves. A three-group quasi-experimental design (instrumental support, instrumental+emotional support, wait-list control) was employed. Outcomes from the perspective of the caregiver, care recipient, and the health system were evaluated. In this paper, we further describe the experimental design of the program, the role o...

Purpose of the study To test fidelity and preliminary efficacy of Tele-Savvy, an internet-based version of the in-person, evidence-based psychoeducation Savvy Caregiver Program (SCP) for dementia caregivers. Tele-Savvy used synchronous (tele-conferences) and asynchronous components (video modules) to provide program access to caregivers in their homes. Design and methods SCP experts were surveyed to evaluate Tele-Savvy's fidelity to SCP. A convenience sample of 30 dementia caregivers from the Atlanta VA Medical Center enrolled in the Tele-Savvy clinical demonstration program. Twenty-two caregivers completed both pre- and postprogram evaluations, which included measures of caregiver stress and competence and behavioral and psychological symptoms of dementia (BPSD). Results Expert review confirmed Tele-Savvy's fidelity with and, in certain domains, improvement on the original. Participants demonstrated moderately high initial levels of burden, anxiety, and depressive symptoms all of which decreased significantly postprogram in an intention to treat analysis. Similar reductions were seen in care recipients' BPSD and caregivers' reactions to them. Marginally significant increases in caregiver competence were observed. Caregiver and expert panel evaluations of program quality were enthusiastic. Implications An effective online caregiver psychoeducation program could provide greatly expanded access for caregivers who cannot attend in person for reasons of distance, transportation limitations, and caregiving responsibilities. Further testing in a controlled trial is needed to establish program efficacy.

Objectives To examine the effect on mobility self-efficacy of a multifactorial, individualized, occupational/physical therapy (OT/PT) intervention delivered via teletechnology or in-home visits. Design Randomized, clinical trial. Setting One Department of Veterans Affairs and one private rehabilitation hospital. Participants Sixty-five community-dwelling adults with new mobility devices. Thirty-three were randomized to the control or usual care group (UCG), 32 to the intervention group (IG). Intervention Four, once-weekly, 1-hour OT/PT sessions targeting three mobility and three transfer tasks. A therapist delivered the intervention in the traditional home setting (trad group n = 16) or remotely via teletechnology (tele group n = 16). Measurements Ten-item Likert-scale measure of mobility self-efficacy. Results The IG had a statistically significantly greater increase in overall self-efficacy over the study period than the UCG (mean change: IG 8.8, 95% confidence interval (CI) = 3.8-13.7; UCG 1.2, 95% CI = -5.8-8.2). Descriptively, the IG exhibited positive changes in self-efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair. Comparisons of the two treatment delivery methods showed a medium standardized effect size (SES) in both the tele and trad groups, although it did not reach statistical significance for the tele group (SES: tele = 0.35, 95% CI = -2.5-0.95; trad = 0.54, 95% CI = 0.06-1.14). Conclusion A multifactorial, individualized, home-based OT/PT intervention can improve self-efficacy in mobility-impaired adults. The trend toward increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in-home therapy.

OBJECTIVES: To improve nighttime sleep in nursing home patients. DESIGN: Controlled clinical trial. SETTING: Eight community nursing homes enrolled two at a time. PARTICIPANTS: Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate-intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate-intervention group and 83 in the delayed-intervention phase). INTERVENTION: Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention. MEASUREMENTS: Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations. RESULTS: There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate-intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography. CONCLUSION: This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.

Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were “responders” based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care.

Objective To examine the applicability and feasibility of an intervention directed at improving continence, endurance, and strength (Functional Incidental Training [FIT]), for older patients in Veterans Administration (VA) nursing homes. Design Data were collected during a randomized, controlled, crossover trial. Setting Four VA nursing homes. Participants All 528 patients in the nursing homes were screened, 178 were eligible, and 107 were randomized into the trial. A total of 64 participants completed the intervention phase of the trial. Intervention Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength training exercises offered four times per day, 5 days per week, for 8 weeks. Measures Descriptive data were collected relevant to the translation of the FIT intervention into everyday practice, including number of patients eligible and reasons for ineligibility, attrition rates and reasons for attrition, participant adherence to and satisfaction with FIT, and the costs of FIT relative to usual care. Results One third of the 528 patients met the eligibility criteria. The major reasons for ineligibility were being continent, age under 60, and a short anticipated length of stay. Of the 146 patients enrolled in the trial, 85 (58%) dropped out during the 9- to 10-month project. Deterioration in health status, death, and discharge accounted for two thirds of the attrition. Adherence to FIT was in general high but variable. Participants completed prompted voiding plus at least one exercise in 75% of the FIT rounds offered. Of the 60 participants who completed the protocol and who could answer simple questions, 75% indicated they enjoyed FIT, but 62% indicated that the exercise was too frequent, and 28% indicated they were offered opportunities to toilet too often. Based on timed observations, the costs of FIT are about four times as high as usual continence care. Conclusions FIT is applicable to a substantial number of patients in VA nursing homes. The FIT protocol tested in this trial can be further refined and individualized based on patient preferences and adherence to various components of FIT in order to make it more feasible, efficient, and cost-effective in practice. The costs of maintaining an intervention such as FIT in all VA nursing home patients who may benefit, however, are high and must be justified largely by potential positive effects on function and quality of life, as opposed to cost savings resulting from the intervention.

Increased numbers of sensors on wells do not result in increased production. New methods of data analysis are needed to capitalize on the new data. A novel approach to modelling gas coning has been developed for one of BP’s assets. It integrates several data-driven models representing different aspects of a well’s performance. Prior art, as exemplified by other approaches in BP and other case studies in the literature, is discussed. A description of the field and its operational issues around gas production is given. The details of the methodology that has been used are provided. The novelty relative to the prior methods described in literature is discussed. Advantages of the data-driven approach are explored, incorporation of the models into real-time operational support systems is considered, and other opportunities for leveraging available data to maximize the value from our operations are mentioned. The approach has been tested on a North Sea reservoir. An interconnected suite of models for reservoir pressure, indication of the presence of gas coning, virtual flow measurement for fluids and gas production, and dynamic prediction for future fluids and gas rates, was developed. The suite of models predicts fluid and gas rates for use in short-time-loop optimizations. Models use the available real-time data, which includes bottom-hole pressure, wellhead pressure, choke changes, and gas lift rate. The data is captured for production, injection and observation wells. The methodology assists in the prediction of the dynamic well behavioral changes which result from the onset or occurrence of gas coning. It enables the asset to leverage its real-time sensor data to manage and optimize its wells while respecting the facility’s constraints. It works for similar assets where dynamic well behavior must be managed.

This study examined the accuracy of new wheelchair user predictions about their future wheelchair use.This was a prospective cohort study of 84 community-dwelling veterans provided a new manual wheelchair.The association between predicted and actual wheelchair use was strong at 3 mos (ϕ coefficient = 0.56), with 90% of those who anticipated using the wheelchair at 3 mos still using it (i.e., positive predictive value = 0.96) and 60% of those who anticipated not using it indeed no longer using the wheelchair (i.e., negative predictive value = 0.60, overall accuracy = 0.92). Predictive accuracy diminished over time, with overall accuracy declining from 0.92 at 3 mos to 0.66 at 6 mos. At all time points, and for all types of use, patients better predicted use as opposed to disuse, with correspondingly higher positive than negative predictive values. Accuracy of prediction of use in specific indoor and outdoor locations varied according to location.This study demonstrates the importance of better understanding the potential mismatch between the anticipated and actual patterns of wheelchair use. The findings suggest that users can be relied upon to accurately predict their basic wheelchair-related needs in the short-term. Further exploration is needed to identify characteristics that will aid users and their providers in more accurately predicting mobility needs for the long-term.

Background and Purpose— To determine the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on physical function, and secondarily on disability, in veterans poststroke. Methods— We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers. Veterans with a stroke in the preceding 24 months were randomized to the STeleR intervention or usual care. The STeleR intervention consisted of 3 home visits, 5 telephone calls, and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies. Usual care participants received routine rehabilitation care as prescribed by their physicians. The primary outcome measures were improvement in function at 6 months, measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument. Results— The 2 complementary primary outcomes (Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure) improved at 6 months for the STeleR group and declined for the usual care group, but the differences were not statistically significant ( P =0.25, Late-Life Function and Disability Instrument; P =0.316). Several of secondary outcomes were statistically significant. At 6 months, compared with the usual care group, the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P P =0.06). Conclusions— The STeleR intervention significantly improved physical function, with improvements persisting up to 3 months after completing the intervention. STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited resources available for in-home rehabilitation for stroke survivors. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00384748.

A randomized controlled pre-post intervention study was undertaken to assess changes in task self-efficacy after a four-week intervention protocol. The intervention groups received once-weekly, one-hour therapy sessions targeting 3 mobility and 3 transfer tasks delivered either by Traditional In-Home Therapy or remote interactive Tele-Technology. Participants completed a 10-item, Likert scale measure of task self-efficacy at enrollment and after four weeks. Overall the intervention groups had a statistically significant increase in self-efficacy compared to the control. Comparisons between the two treatment delivery methods showed a medium standardized effect size (SES) in both groups compared to controls, although it did not reach statistical significance for the Tele group (SES Tele 0.35 [-2.5-.95]; Trad 0.54 [0.06-1.14]). Although further study is needed, this trend towards increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that tele-rehabilitation can be a viable alternative to traditional in-home therapy.

Telerehabilitation (TR) is the use of telehealth technologies to provide distance support, rehabilitation services and information exchange between people with disabilities and their clinical providers. This article discusses the barriers experienced when implementing a TR multi-site randomized controlled trial for stroke patients in their homes, and the lessons learned from conducting the study. The barriers are divided into two sections: those specific to TR and those pertinent to research overall. The TR specific barriers included the rapidly changing telecommunications and health care environment and inconsistent equipment functionality. The barriers applicable to research overall included the need for telehealth research to meet regulations in diverse departments and the rapidly expanding and changing research regulations. Solutions to the barriers included having various telehealth equipment available to allow for functionality with the currently diverse telecommunications infrastructure, rigorous pilot testing all equipment in different situations, and having biomedical engineering staff on-call and on-site.

Background Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. Methods We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. Discussion For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans. Trial Registration Clinical Trials.gov Identifier: NCT00384748